Acta Gastroenterológica Latinoamericana ISSN: 0300-9033 [email protected] Sociedad Argentina de Gastroenterología Argentina
De Paula, Juan Andrés; Carmuega, Esteban; Weill, Ricardo Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation Acta Gastroenterológica Latinoamericana, vol. 38, núm. 1, marzo, 2008, pp. 16-25 Sociedad Argentina de Gastroenterología Buenos Aires, Argentina
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Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation Juan Andrés De Paula,1 Esteban Carmuega,2 Ricardo Weill 3
1 Gastroenterology Division - Hospital Italiano of Buenos Aires, Argentina 2 Nutritia 3 Danone Argentina Acta Gastroenterol Latinoam 2008;38:16-25
Summary lue in the basal period, did not experience changes. Background/aims: functional constipation is a preva- Conclusion: the consumption of a symbiotic yogurt by lent problem within the western population. There is women with functional constipation showed a signifi- evidence supporting the fact that the inclusion of pre cant improvement in the parameters related with bowel and probiotics in the diet can favorably modify the in- evacuation. The use of this symbiotic food can result in testinal function. The present study evaluates the effect a useful and safe tool for managing constipation. of the consumption of Activia ®, a yogurt containing Key words: Constipation, Probiotics, Prebiotics, 10 8 UFC/g of Bifidobacterium animalis (DN-173 Intestines, Colon. 010) and fructoligosaccharide, in women between the ages of 18 and 55 with and without functional consti- pation (Rome II criteria). Methods: after a stabiliza- tion and a basal period, women were randomized to re- Efecto de la ingesta de un alimento ceive 2 units/day of Activia or a lacteous dessert without simbiótico sobre el hábito evacuatorio probiotics (control) for a period of 14 days. Afterwards en mujeres con constipación funcional the groups were intercrossed for another 14 days. Resumen Results: of the 399 women who started the study, 378 Introducción/objetivos: la constipación funcional es were eligible for study participation. In the group of wo- un problema prevalente en la población occidental. men with functional constipation (n= 266), the con- Existen evidencias de que la toma de alimentos pre y sumption of the symbiotic was associated with a higher probióticos puede modificar favorablemente el hábito bowel evacuation rate (6.1±2.7 depositions/week with evacuatorio intestinal. En este trabajo se estudió el efec- Activia vs. 5.0±2.6 dep./week in the control group; to de la ingesta de Activia ®, un yogur conteniendo 10 8 P<0.01), an improvement in the quality of the stools UFC/g de Bifidobacterium animalis (DN-173 010) y according to the Bristol scale (3.6±1.0 vs. 3.4±1.0; un fructoligosacárido en mujeres de 18 a 55 años con y P<0.01), a reduced perception of straining effort sin constipación funcional (criterios de Roma II). (1.9±0.8 vs. 2.2±0.9; P<0.01) and a reduced percep- Métodos: luego de sendos períodos de estabilización y tion of pain associated with defecation (0.1±0.2 vs. basal fueron aleatorizadas a recibir durante 14 días 2 0.2±0.3; P<0.01). In the group of women without unidades/día de Activia o de un postre lácteo sin pro- constipation (n=112) there were statistically significant biótico ni prebiótico (control). Luego los grupos fueron variations in equal sense but of smaller magnitude, entrecruzados durante otros 14 días. Resultados: de las with the exception of pain which, having a very low va- 399 mujeres que iniciaron el estudio, 378 fueron eva- luables. En el grupo de constipadas (n= 266) la toma Correspondence: Juan Andrés De Paula del simbiótico se asoció con una mayor frecuencia eva- Servicio de Gastroenterología - Hospital Italiano. Gascón 450, cuatoria (6,1±2,7 dep./semana con Activia vs. (C1181ACH). Ciudad Autónoma de Buenos Aires, Argentina. 5,0±2,6 dep./semana en controles; P<0,01), mejoría Tel: (54-11) 4959-0200 interno 8862 Fax: (54-11) 4959-0200 interno 8294 en la escala de Bristol de calidad de las heces (3,6±1,0 E-mail: [email protected] vs. 3,4±1,0; P<0,01), menor esfuerzo evacuatorio
16 Symbiotic yogurt and functional constipation Juan Andrés De Paula y col
(1,9±0,8 vs. 2,2±0,9; P<0,01) y menor proporción de ders associated with constipation are referred spon- dolor evacuatorio (0,1±0,2 vs. 0,2±0,3 ; P<0,01). En taneously by one third of the people. In recent el grupo sin constipación se observaron variaciones esta- investigations carried out in representative samples dísticamente significativas en igual sentido pero de me- of the argentinean urban population, 27% of the nor magnitud, con excepción del dolor que mostró un respondents spontaneously referred problems rela- valor basal muy bajo. Conclusión: la ingesta del yogurt ted to constipation as being a main motive of pre- prebiótico en mujeres con constipación funcional mos- occupation concerning their health. Of these peo- tró una mejoría significativa de los parámetros relacio- ple, 78% perceived inconveniences associated with nados con la evacuación intestinal. La utilización de constipation at least once a week, 60% of which este alimento simbiótico puede resultar una herramien- reported seeking a solution to this affection throug- ta útil y segura en el manejo de la constipación. hout their diet.6 Palabras claves: Constipación, Probiótico, Prebiótico, There is evidence supporting the fact that the inta- Intestinos, Colon. ke of probiotics can be useful to reduce the affections related with constipation. Three different clinical List of abbreviations: studies,7-9 have demonstrated that the consumption Fructoligosaccharide (FOS) of Activia ®‚ on a daily basis improves colonic transit time and that such effect is dose-dependent. Other Constipation is one of the most prevalent com- studies performed in human volunteers have confir- 10 ® plaints referred by the general population.1 It can be med this benefit. Activia (Danone Argentina) is a secondary to multiple causes, however, in healthy yogurt containing Bifidobacterium animalis DN 8 people it is principally attributed to many of their 173010 (10 colony forming units -CFU- per gram habits that characterize the current lifestyle. The of product) with the natural yogurt starter bacteria: abundance of refined foods, the poor intake of die- Lactobacillus bulgaris and Streptococcus thermophilus tary fiber or non-digestible residues and physical (10 7 CFU/g of product), with the addition of a small inactivity are probably important factors involved in proportion (0,5 g%) of inulin. Inulin is a fructoligo- the genesis of this disorder. Constipation is more saccharide (FOS) which is obtained from a natural frequent in women, probably due to a hormonal fiber of chicory (chicorium intybus), a polymer of effect,2 many times aggravated during pregnancy 3 fructose containing 1-4 bonds with prebiotic acti- and/or secondary to the anatomic and functional vity, which stimulates the proliferation of bifidobac- changes in the dynamics of the pelvic floor follo- teria in the intestinal tract.11 The addition of inulin wing delivery. to an exogenous bifidobacteria substantially increa- There is no single definition of constipation. ses the proportion of bifidobacteria in the colonic Most patients define constipation by one or more flora.12 Experimental studies with this combination symptoms: hard stools, infrequent stools (typically called Acti regularis have confirmed that it is capable fewer than three per week), the need for excessive of substantially increasing the concentration of bifi- straining effort, sensation of incomplete bowel eva- dobacteria in both caecum homogenates and colon cuation, an excessive time spent on the toilet or in of mice in vivo, of favorably modifying the produc- unsuccessful defecation.4 The operative definitions tion of organic acids and of decreasing the formation of constipation were built from a combination of of colonic enzymes such as nitroreductase which are parameters; such is the case of the Rome II criteria involved in the transformation of pro-carcinogens used in the current study. into carcinogens.13 In a study published in 1987 in the United States The main objective of this study was to determi- carried out presumptively amongst healthy young ne whether the consumption of Activia, a symbiotic adults, Sandler and Drossman reported a prevalence of yogurt (dairy product) with probiotics and prebio- constipation of 7.3%. Subjects most commonly defi- tics, modifies the principal characteristics and the ned constipation as straining effort and hard stools.5 subjective sensations associated with bowel evacua- Based on the register of the number of depositions tion, evaluated through the stool frequency, stool per week, constipation affects 10% of the popula- shape (Bristol stool scale), straining effort and eva- tion in our country. However, the unspecific disor- cuation pain.